We read the article by Kothari et al.1 with interest. In this study, 9 of 13 patients with invasive breast carcinoma (69%) experienced disease recurrence and died. Such a high mortality rate indicates the need for the careful selection of both local and adjuvant systemic therapy to maximize the possibility of cure in this very young age group. In the study by Kothari et al.,1 no patients underwent mammography, and only one patient had undergone an ultrasound. Furthermore, two patients had a family history of breast carcinoma, including disease occurring in first-degree relatives. In nearly all patients, the only preoperative diagnostic method used was palpation. However, in the event of a palpable breast mass, we use imaging modalities for several purposes: 1) to define better the nature of the mass, 2) to detect unexpected ipsilateral or contralateral tumors, and 3) to identify a nonpalpable extensive intraductal component to reduce the possibility of recurrence after breast-conservation therapy.2 In women age <30 years, ultrasonography is the preferred initial imaging modality for the evaluation of a palpable mass. If ultrasonography identifies a suspicious abnormality, mammography should be performed to identify possible multifocal lesions or an intraductal component of an invasive tumor.2 Preoperative ultrasonography especially improves planning the conservative management of breast carcinoma.3 Moreover, contrast-enhanced magnetic resonance imaging may reveal unsuspected multifocal, multicentric, or contralateral breast carcinoma and result in changes in therapy.4 We cannot understand why Kothari et al. did not use preoperative imaging modalities.


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Selda Tez M.D.*, Cenap Dener M.D.†, * Department of Radiology, Fatih University, School of Medicine, Ankara, Turkey, † Department of Surgery, Fatih University, School of Medicine, Ankara, Turkey